Healthcare Provider Details

I. General information

NPI: 1477519163
Provider Name (Legal Business Name): LUIS ADALBERTO MORENO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 E FLAMINGO RD
LAS VEGAS NV
89121-6227
US

IV. Provider business mailing address

11700 W CHARLESTON BLVD
LAS VEGAS NV
89135-1573
US

V. Phone/Fax

Practice location:
  • Phone: 818-515-7035
  • Fax:
Mailing address:
  • Phone: 818-515-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA72309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number24727
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24727
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: